|Sedation and Analgesia on ITU
Give dose slowly according to effect. Always be prepared to manage respiratory depression with Naloxone and resuscitation equipment. Some people are over sensitive
- Opiate. See BNF or equivalent for UpToDate prescribing advice
Mode of action
- Strong opiate acts on opioid receptors
- Consider starting at 2.5 mg if frail and elderly
- Acute Severe Pain: Morphine 5-10 mg SC/IM 4 hourly (give one third to half dose if IV route)
- Acute MI: Morphine 2.5-5 mg slow IV stat over watch for respiratory depression
- Acute LVF: Morphine 2.5-5 mg slow IV stat over 5 mins watch for respiratory depression
- Chronic pain: Morphine 20-30 mg PO daily is safe for opioid-naive patients and 40-60 mg daily for patients being switched from a regular weak opioid.
- Give as slow-release MST (Continus) 10 mg BD and slowly increase.
- Palliation: Morphine 10-20 mg in Syringe driver over 24 hrs increased as needed
- Usually combined with anti-emetic
Dose Range: Morphine doses can increase over time if indicated
|Morphine Sulphate (Short acting e.g. Oramorph 10 mg/5ml) ||5-10 mg||Every 4 hours PRN||PO (Max dose 120 mg/day . For breakthrough pain. Increase BD dose.)|
|Morphine Sulphate (Long acting e.g. Modified release) || 10 mg||12-hourly. ||PO. Up titrate as needed|
|Morphine Sulphate || 2.5-5 mg||4-hourly PRN for pain, LVF, operative||IV/SC/IM|
|Morphine Sulphate ||10-20 mg/24 hrs||Syringe pump SC Often for palliation||IV/SC/IM|
- Avoid with MAOIs now or recent usage. See BNF for a full list.
- Avoid with other sedating drugs
- Can worsen hypotension and respiratory depression
- Reduce dose in liver, renal failure, heart failure or elderly
- Respiratory depression, Severe COPD, Muscle weakness, Myasthenia
- Bowel obstruction or ileus.
- Nausea, vomiting, Constipation, Ileus, Itch, hypotension, sedation
- Dry mouth, urinary retention, reduced cough reflex, anorexia
- Delirium, restlessness, seizures, miosis, bronchospasm
- Biliary tract spasm, low libido, rhabdomyolysis